Sheath for sealed access to a vessel

ABSTRACT

A sheath for producing a fully sealed access to the interior of a vessel of an animal or human body comprises a base sheath having a tubular body defining a pass-through channel. The base sheath is adapted to be inserted into the vessel through a vessel aperture. A wall of the tubular body of the base sheath has a through channel. This channel extends in the wall from the distal end towards the proximal end. The channel can be present separately from the pass-through channel of the base sheath or can form a sideways extension of the pass-through channel, at least at the distal end. Such through channel is adapted to conduct blood from the vessel to the proximal end of the sheath when the sheath has been inserted into a vessel.

The present invention relates to a sheath for producing a fully sealedaccess to the interior of a vessel of an animal or human body, forexample an artery.

Sheaths are employed in different forms during percutaneousinterventions on the human body, for example when introducing a heartcatheter via an artery or vein, for example the femoral artery.Different steps of such an intervention will be set forth hereinafter ina brief and simplified form to lead up to the object of the invention.

In a first phase, the vessel is punctured for this purpose with apuncture needle. Through this needle a first guidewire is then insertedinto the vessel. The needle is removed and a first sheath is insertedinto the vessel along the guidewire. The above steps are carried outaccording to the well-known “Seldinger technique”. This sheath normallycomprises a base sheath, a removable dilator and a hemostatic valve atthe proximal end of the sheath, i.e. at the end of the sheath facing thepractitioner's body. In connection with the present invention theanatomical direction terms will be chosen with reference to thepractitioner. The sheath possesses an outer diameter of about 2 mm. Thedilator and the guidewire are successively removed, so that only thebase sheath of the first sheath remains partially in the vessel.

In a second phase, a stiff guidewire is now inserted into the vesselthrough the remaining base sheath, for example up to a depth of 40 cm.Thereafter the base sheath is removed. The guidewire remains partiallyin the vessel.

Optionally this can be followed by a further pre-dilation, which shallnot be described here. Optionally or alternatively, instead of applyinga small intermediary sheath, the puncture into the vessel can beup-dilated by applying various sizes of dilators over the originallydeployed guidewire.

Along the guidewire remaining in the vessel, that sheath is now insertedinto the vessel through which the heart pump is to be introduced. In thecontext of the present application, an “introducer” or an “introducingsheath” is a sheath having a hemostatic valve. This introducing sheathnormally possesses an inner diameter of from about 4.5 to 5 mm and anouter diameter of from about 5 to 6 mm. The basic structure of theintroducing sheath is identical to the structure of the above-mentionedfirst sheath, i.e. it consists of an outer base sheath, a dilator and ahemostatic valve. Dilator and guidewire are removed again, with the basesheath of the introducing sheath remaining in the blood vessel. Theaccess for the heart pump has now been created.

Through the base sheath a guide catheter is now normally placed alongthe artery into the left ventricle. For this purpose there can beemployed for example a so-called pigtail catheter, which consists of athin tube and a soft distal precuved guiding tip. A supporting guidewiremay already be inserted into the guide catheter extending therein, whichsupports the catheter. Said soft, supporting wire is thereafter removed,and a harder guidewire is inserted into the heart through the catheter.Along the hard guidewire the heart pump is inserted into the heart,after removal of the pigtail catheter. The inlet of the heart pump isthen located in the left ventricle, the outlet in the aorta and theguidewire is retrieved. The pump is connected to a supply catheter whichextends along the artery employed for placing the pump and which exitsat the vessel aperture (puncture side). Alternatively, the pump candirectly be inserted into the base sheath and can be delivered into theheart without the need for additional guide catheters and guidewires incase the pump has been designed with the appropriate features necessaryto retrogradely pass the aortic valve in a trauma free manner.

The introducing sheath that has been employed for inserting the heartpump is now removed from the vessel and pulled out completely beforefinal removal is performed, for example by splitting along apredetermined separating line (“peel-away” technique). To now close thevessel at the vessel aperture again, i.e. to close the gap between thecircumference of the hole in the vessel and the outer diameter of thesupply catheter of the pump, a further sheath is inserted into thevessel along that portion of the heart-pump supply catheter that islocated outside the body. The last-mentioned sheath is the subjectmatter of the present invention. Because it is also possible to displaceor reposition the heart pump through this sheath, for example via thesupply catheter, the sheath is also called a repositioning sheath (or“repo sheath”).

To avoid a blood flow disturbance in the artery and potential low flowor foreign surface related thrombosis, the sheath should only beinserted into the vessel as deep as necessary and have an outer diameterjust sufficient to close the vessel in a fully sealed manner, i.e. tostop bleeding or oozing that would otherwise occur.

It is hence desirable to be able to reliably recognize whether and whenthe sheath has been inserted deep enough into the vessel. This can varydepending on the thickness of the subcutaneous fatty tissue to bepenetrated and/or the angulation of the access and hence be difficult todetermine.

The object of the present invention is therefore to propose a sheaththat enables recognition of a sufficient penetration depth.

This object is achieved by a sheath and a method having the features ofthe independent claims. Advantageous embodiments and developments arestated in the dependent claims.

The sheath comprises for this purpose a base sheath having a tubularbody defining a pass-through channel. Normally the sheath comprises aconventional hemostatic valve at the proximal end. The base sheath isadapted to be inserted into the vessel through a vessel aperture, i.e.to be installed in the vessel through the vessel aperture.

To enable recognition of the penetration depth, a wall of the tubularbody of the base sheath has a through channel. This through channelextends in the wall from the distal end towards the proximal end. Thethrough channel may exit the wall of the tubular body to the outside ofthe sheath at the proximal end of the sheath or earlier, i.e. betweenthe distal end and the proximal end of the sheath. The through channelcan be present separately from the pass-through channel of the basesheath. According to an alternative embodiment, the through channel canbe formed as a sideways extension of the pass-through channel, at leastat the distal end, i.e. it has not to be separate from the pass-throughchannel over its entire length. Such through channel is adapted toconduct blood from the vessel to the proximal end of the sheath when thesheath has been inserted into a vessel. In this way one can reliably seeas soon as the sheath has been inserted into the vessel through thetissue at sufficient depth. In other words, the channel enables a kindof insertion depth indicator to be obtained, simply by the fact that assoon as blood from the vessel becomes recognizable at the proximal endof the channel, a sufficiently deep insertion of the sheath into thevessel can be inferred. There is in particular no danger of the sheathbeing inserted further into the vessel than necessary, which couldotherwise cause blood flow disturbances.

Advantageously, blood can also be taken for diagnostic purposes throughthe channel in a suitable manner. Significant diagnostic methods hereare in particular measurement of the patient's blood pressure and adetermination of the cardiac output. For measuring blood pressure, thesheath can further comprise a blood pressure measuring device which isconnected to the channel. The cardiac output can be determined forexample by means of thermodilution. For this purpose, the sheath cancomprise a temperature measuring element, for example a thermistor,inserted through the channel.

The sheath can further comprise a guidewire which is preferablyinstallable through the channel. In other words, the channel is thenadapted to insert the guidewire into the vessel from the proximal end ofthe sheath via the channel. Via such a guidewire vessel access ismaintained even after withdrawal of the pump.

According to a preferred embodiment, the sheath comprises an expansiondevice. The latter is adapted to cooperate with the base sheath suchthat the outer diameter of the sheath increases in the region of thevessel aperture with the sheath in a stationary position in the vesseland upon actuation of the expansion device.

For producing a fully sealed access to a vessel by means of thisembodiment of the sheath, the sheath is therefore inserted into thevessel through the vessel aperture. Thereafter the outer diameter of thesheath is increased as needed in the region of the vessel aperturethrough actuation of the expansion device of the sheath.

To increase the outer diameter of the sheath in case of need, it isunnecessary to insert the sheath deeper into the vessel, because anincrease of the outer diameter of the sheath in the region of the vesselaperture is possible with the sheath in a stationary position. Since thesheath has a relatively small outer diameter in its initial state, i.e.without actuation of the expansion device, one can avoid an unnecessarywidening of the vessel aperture as well as a blood flow disturbance inthe vessel due to a large outer diameter or long penetration depth.

It is intended to design the repositioning sheath so that it isinitially undersized, e.g. the initial outer diameter of the sheath canbe up to 4 F (=1.33 mm) smaller in diameter as compared to the initialpuncture diameter created by the introducing sheath for the pump. Thereason for this undersized outer diameter is that the vessel itself mayhave the ability to recoil elastically to a smaller hole if the initiallarger sheath is placed only for a short period (<60 min). It will beappreciated that the smallest obdurator which achieves hemostasis is themost preferred embodiment with the least amount of foreign material inthe vessel and the smallest likelihood of full vessel obstruction anddiscontinued distal perfusion. Only in case of no or limited vesselrecoil the expanding portion of the repositioning sheath will beexpanded gradually in order to obtain hemostasis. In a preferredembodiment the expanding device is configured such that an expandingportion of the sheath is confined to the target area around the vesselpuncture allowing for the proximal sheath, which extends through theskin to the outside of the body, to be recessed. In this way, bleedingwould still be visible at the skin level requiring a further expansionof the expanding portion. Henceforth, it is less likely to plug thepuncture at the skin level and potentially have continuous bleeding atthe vessel puncture into the adjacent tissue, which would later show upas a circular hematoma.

According to a further preferred embodiment, the expansion device isconfigured as an expansion sheath displaceable on the sheath in thedirection of the vessel aperture. Such expansion sheath can for exampletubularly encompass the base sheath. By displacing the expansion sheathon the base sheath in the direction of the vessel aperture, one canincrease the outer diameter of the sheath in the region of the place ofentry into the vessel, without inserting the sheath as a whole deeperinto the vessel.

A plurality of embodiments of an expansion device that diverge from theabove are possible. For example, an expansion device can be providedthat is not displaced on the base sheath in the direction of the vesselaperture, but that is arranged in the pass-through channel of the basesheath or around the base sheath. Such an expansion device can basicallybe structured like a dilator and for example widen the base sheath, or asleeve arranged on the base sheath (to be described more exactlyhereinafter), from the inside, for example like a balloon dilator. Theballoon dilator can also be arranged on the outside of the sheath.According to a preferred embodiment, an expansion device in the form ofa spiral inflation tube is provided, which is preferably arrangedbetween the base sheath and the sleeve. The inflation tube is spirallywound around the base sheath. During inflation of the tube, the sheathis expanded while still being flexible, i.e. bendable, in the expandedarea.

Instead of a balloon dilator or the like there can also be provided amechanical spreading element, for example a wire mesh-like stent. Such aspreading element can be brought from a contracted to an expandedposition, for example by rotation or displacement of an actuatingelement arranged at the proximal end of the sheath and coupled with thespreading element, so that the outer diameter of the sheath increases inthe region of the spreading element. According to a preferredembodiment, the sheath comprises a flexible portion in the area to beexpanded. This flexible portion forms a part of the base sheath and isarranged between the proximal end and the distal end. The flexibleportion can be expanded by operating a pulling means which is connectedto the base sheath at the distal end.

According to a further preferred embodiment, the sheath comprises, as anexpansion device, a stretchable portion in the area to be expanded. Thisstretchable portion forms part of the base sheath and is arrangedbetween the proximal end and the distal end. The stretchable portion isconfigured to attain a first thickness in a stretched condition and asecond thickness, which is larger than the first thickness, in anunstretched condition, so as to increase the outer diameter of thesheath when the proximal end portion of the base sheath is released indirection of the vessel aperture from the stretched condition to theunstretched condition. In other words, the sheath having the stretchableportion offers the smallest outer diameter in a stretched condition. Byreleasing the stretching—from the proximal end of the sheath indirection of the vessel aperture—the stretchable portion attains anunstretched condition which results in a larger outer diameter of thesheath in the area of the vessel aperture. This embodiment isadvantageous in case the sheath has a minimum wall thickness thatprecludes a uniform compression by axial displacement.

An arbitrary other form of analogous spreading, expanding or wideningapparatus can be provided as an expansion device. In just anotherembodiment the expansion can be automated by swelling a material withthe surrounding blood (e.g. a hydrophilic gel), which only expandsgently to the “right size” with minimal stress to the vessel byappropriate choice of the swelling modulus.

According to a further preferred embodiment, the sheath comprises asleeve, as already indicated. The sleeve encases the base sheath and theexpansion device such that the sleeve is in contact with the vesselaperture when the sheath has been inserted into the vessel, i.e. withthe sheath in a stationary position in the vessel. This can prevent atraumatic effect of the expansion device on the vessel when theexpansion device is actuated, in particular advanced, for increasing theouter diameter of the sheath. This sleeve serves as well as a sterilebarrier and allows the insertion of non sterile expanders from theproximal end of the repositioning sheath.

In case the expansion device is configured in the form of thehereinabove described expansion sheath that is displaceable on the basesheath, the sleeve encases the base sheath and the expansion sheath suchthat the expansion sheath is displaceable on the base sheath between thebase sheath and the sleeve.

Preferably, the base sheath has a pass-through channel having an innerdiameter through which a catheter, preferably a supply catheter of aheart pump, can be guided. An inner diameter of about 3 mm may besufficient for this purpose. It will be appreciated that the innerdiameter of the sheath can be adjusted in accordance with the intendedapplication and can also be paired and operated with any otherindwelling device.

Preferably, the outer diameter of the sheath is chosen sufficientlylarge that a vessel aperture arising upon insertion of a heart pumpthrough the vessel is closed in a fully sealed manner, ideally withoutactuation of the optional expansion device. An outer diameter of about3.33 mm to 5 mm is sufficient for this purpose in view of currentlyemployed heart pumps and introducing sheaths for introducing the pumps.It will be appreciated that the outer diameter of the sheath can also beadjusted, i.e. reduced or increased, in view of the application. But itshall be mentioned that vascular complication rates exponentiallyincrease above 5 mm, which is why the preferred target size should aimat the smallest possible diameter which achieves hemostasis.

The expansion device of the sheath is preferably adapted to increase theouter diameter of the sheath in the region of the vessel aperture byabout 1 F to 3 F (0.33 mm to 1.00 mm), preferably by about 1 F to 4 F(0.33 mm to 1.33 mm), particularly preferably by about 1 F to 5 F (0.33mm to 1.66 mm). In this way it can be ensured that a fully sealed accessto the interior of the vessel is produced in different scenarios, inparticular in view of different patients with different vessel recoilpotential and vessel sizes.

Further to having a correct sealing diameter, it is equally importantthat an expanding portion of the sheath is “radially soft”. In thiscontext, radially soft means that this portion must not act like a stiffportion, which can distort and/or traumatize the vessel, but that thisportion can still confine to the curvature/radius at which therepositioning sheath enters into the vessel. This mandates low durometerpolymeric materials and/or a special design of the expansion device,e.g. a helically wound inflation tube (already mentioned above). Thelatter can radially expand, but will not exceed any tangential forcecausing the pre-curved portion to stretch longitudinally or stretch out.

The degree of expansion of the outer diameter of the sheath is eitherguided by the inflation pressure of a balloon or any other means offorce feedback that could be used to limit the expansion to a diametersufficient to provide hemostasis. An expanding force slightly above themaximum blood pressure is considered to be sufficient. The expandingforce can be considered equal to the inflation pressure of a balloon ifthe balloon material is highly compliant.

According to a further preferred embodiment, the sheath comprises afixation element at the proximal end. Said fixation element serves forfixing the sheath to a patient after insertion of the sheath into thepatient's vessel. The fixation element can thus be stitched to thepatient's skin, for example. The fixation element comprises an areaspanning the base sheath for applying a sterile cover. The area slopesdown in a ramp shape on both sides of the base sheath transversely tothe principal direction of the base sheath.

Such an embodiment of the fixation element allows a simple and safeapplication of the sterile cover and thereby minimizes the places ofentry for germs and pathogens at the vessel aperture.

The fixation element can additionally comprise a fixation area whichlies on the patient's skin in the fixed state. The fixation area is thenlocated opposite the above-mentioned area for applying the sterilecover.

Preferably, the fixation element further comprises a guide element. Saidguide element serves as a stop for applying the sterile cover.Preferably, the guide element extends at the proximal end of the areatransversely to the principal direction of the base sheath andsubstantially perpendicular to the area, but at least so as to protrudefrom the area such that the functionality of a stop can be provided.Through the application of the sterile cover on the guide element andthrough the configuration of the smooth area for wrinkle-freeapplication of the sterile cover there can be obtained an especiallysafe and sterile covering of the wound. The guide element also helps toprevent an inadvertent fixation of any elements of the repositioningsheath proximal of the fixation element such as the anti-contaminationsleeve used to protect the proximal parts of the catheter fromcontamination.

According to a further preferred embodiment, the sheath comprises aheart pump having a supply catheter. The sheath is here adapted to bearranged displaceably on the supply catheter. In other words, heartpump, supply catheter and sheath form a cohesive system according tothis embodiment.

Hereinafter the invention will be described by way of example withreference to the attached drawings. Therein are shown:

FIG. 1 a preferred embodiment of a sheath according to the invention ina plan view;

FIG. 2 the sheath from FIG. 1 in a lateral sectional view, and

FIG. 3 the sheath from FIG. 1 in a perspective view together withfurther, optional sheath elements.

The representation of the sheath 10 in FIGS. 1 to 3 is not true toscale, but only schematic. For better illustrating some elements of thesheath 10, the actual size relations are thus occasionally incorrect.E.g. tapered portions are exaggerated looking more like slanted stepsrather than a gentle and smooth transition from the smaller to thelarger diameter.

As shown in FIGS. 1 and 2, the sheath 10 serving to produce a fullysealed access to the interior of a vessel of an animal or human bodycomprises a base sheath 20 having a tubular body defining a pass-throughchannel 22. A hemostatic valve 24 (cf. FIG. 3) terminates the sheath atthe proximal end 20 b.

The pass-through channel 22 has an inner diameter d′ and an outerdiameter d. The inner diameter d′ is dimensioned such that the sheath 10is suitable to be pushed over a supply catheter 40 of a heart pump 70(compare FIG. 3) and preferably amounts to about 3 mm. The outerdiameter d preferably amounts to about 3.33 mm to 5 mm, so that thesheath 10 is suitable for closing in a fully sealed manner a vesselaperture arising upon insertion of the introducer of the heart pump 70through the vessel. The outer diameter d may need to be larger than 3.33mm, based e.g. on the minimum wall thickness of the sheath 10, the sizeof a through channel 27 in a wall of the tubular body (cf. FIG. 2), orthe size of the supply catheter 40 (cf. FIG. 3).

The sheath 10 comprises an expansion device in the form of an expansionsheath 26 displaceable on the base sheath 20 in the direction R of thevessel aperture. In the present example the expansion sheath 26 isconfigured as an expansion sheath 26 tubularly encompassing the basesheath 20. The expansion sheath 26 is adapted to be displaced on thebase sheath 20 in the direction R in order to increase the outerdiameter d of the sheath in the region of the place of entry G into thevessel when the sheath 10 has been inserted into the vessel. An outerdiameter D thereafter present in the region of the vessel apertureexceeds the original outer diameter d by the amount 2x, where 2x can beas large as 0.75×d.

The sheath 10 comprises a sleeve 28. The latter is preferably fastenedat its distal end to the base sheath 20 and can furthermore be fastenedat its proximal end to the fixation element 60. The sleeve 28 encasesthe base sheath 20 and the expansion sheath 26 such that the expansionsheath 26 is displaceable on the base sheath 20 between the base sheath20 and the sleeve 28. In this way a traumatic effect of the expansionsheath 26 on the vessel can be prevented and sterility is maintainedwhen the expansion sheath 26 is displaced along the base sheath 20 intothe vessel aperture in order to increase the outer diameter of thesheath 10 in the vessel aperture.

A wall 25 of the tubular body of the base sheath 20 has a throughchannel 27. The latter extends in the wall 25 from the proximal end 20 bto the distal end 20 a of the base sheath separately from thepass-through channel 22 of the base sheath 20 and preferably parallel tothe pass-through channel 22. According to another embodiment (notshown), the through channel 27 is not separate from the pass-throughchannel 22 on its entire length, but e.g. only on the proximal end. Onthe distal end, the through channel 27 can form a sideways extension ofthe pass-through channel 22. The through channel 27 is adapted toconduct blood from the vessel (for example an artery) to the proximalend of the sheath 10 as soon as the sheath 10 has been inserted deepenough into the vessel. In this way a sufficient penetration depth intothe vessel can be ascertained by means of the channel 27 in a simplemanner.

In addition, the sheath 10 can include an externally readable markedregion in an area of the sheath, which, in operation, is intended to belocated in the area of the vessel puncture site. External readabilitycan e.g. be achieved by providing the region with radiopaque markers.Also fluorogenic or echogenic substances can be used for forming themarkers. This region can, according to a first embodiment, which isshown in FIGS. 2 and 3, be defined by two limiting markers 29 a and 29b. These markers further guide the expansion and help locate the correctposition of the sheath in relation to the distal opening of throughchannel 27 and the vessel puncture site thereof. Respective markers cane.g. be provided on the sleeve 28 covering the base sheath 20 and on thebase sheath 20. Alternatively, it is possible to essentially uniformlymark the entire region by adding suitable externally readable substancesto the sheath material in that region. According to such an embodiment,at least part of an expanding portion, such as the above mentionedflexible portion and/or stretchable portion of the sheath, can bemarked.

Further components of the sheath 10 will hereinafter be described withreference to FIG. 3, which shows the sheath 10 in a perspective view.

The channel 27 can be connected via a suitable connection 32, 55 todifferent measuring devices, for example a blood pressure measuringdevice 30. Alternatively or additionally, a temperature measuringdevice, for example a thermistor (not shown), can be connected to orinserted through the channel 27, for example in order to obtaininformation for the measurement of a patient's cardiac output.

100481 Via the channel 27 a guidewire 50 can further be inserted intothe vessel. An access to the channel 27 can be created for example via aLuer connector 55.

As mentioned above, the sheath 10 is suited to be guided via a supplycatheter 40 of a heart pump 70. The heart pump 70, having the catheter40, and the sheath 10 can be provided as a cohesive unit. The heart pump70 is preferably introduced into the patient's vascular system here inthe above-described manner by means of an introducing sheath which isremoved using the peel-away technique and replaced by advancing thesheath 10.

The above-mentioned fixation element 60 serves for fixing, for examplestitching, the sheath 10 to the patient after insertion of the sheathinto a vessel of the patient. For this purpose, openings 66 can beprovided. The fixation element 60 possesses an area 62 spanning the basesheath 20 for applying a sterile cover (not shown). The area 62 of thefixation element 60 slopes down in a ramp shape on both sides of thebase sheath 20 transversely to the principal direction of the basesheath. Further, the fixation element 60 comprises a guide element 64which serves as a stop for applying the sterile cover.

The fixation element 60 may further comprise circulation openings 67and/or circulation opening slots (not shown) in order to allow for aircirculation under the sterile cover. These openings or slots passthrough the fixation element preferably in the direction in which thesheath passes through.

1. A sheath (10) for producing a fully sealed access to the interior ofa vessel of an animal or human body, comprising a base sheath (20)having a tubular body defining a pass-through channel (22), with thebase sheath (20) being adapted to be inserted into the vessel through avessel aperture, characterized in that a wall (25) of the tubular bodyof the base sheath (20) has a through channel (27) extending in the wall(25) from the distal end (20 a) towards the proximal end (20 b).
 2. Thesheath (10) according to claim 1, wherein the through channel (27) ispresent separately from the pass-through channel (22) of the base sheath(20).
 3. The sheath (10) according to claim 1, wherein the throughchannel (27) is a sideways extension of the pass-through channel (22) atleast at the distal end (20 a).
 4. The sheath (10) according to any ofclaims 1 to 3, wherein the through channel (27) is adapted to conductblood from the vessel to the proximal end (20 b) of the sheath (10). 5.The sheath (10) according to claim 4, comprising a blood pressuremeasuring device (30) which is connected to the through channel (27). 6.The sheath (10) according to claim 4 or 5, comprising a temperaturemeasuring element connected to or inserted through the through channel(27).
 7. The sheath (10) according to any of claims 4 to 6, wherein thethrough channel (27) is configured such that blood from a patient can betaken through the through channel (27).
 8. The sheath (10) according toany of claims 1 to 7, comprising a guidewire (50) which is introducibleinto the vessel from the proximal end (20 b) of the sheath through thethrough channel (27).
 9. The sheath (10) according to any of claims 1 to8, comprising an expansion device (26) which is adapted to cooperatewith the base sheath (20) such that the outer diameter (d; D) of thesheath (10) increases in the region of the vessel aperture with thesheath (10) in a stationary position in the vessel and upon actuation ofthe expansion device (26).
 10. The sheath (10) according to claim 9,wherein the expansion device (26) is configured as an expansion sheath(26) that is displaceable on the base sheath (20) in the direction (R)of the vessel aperture.
 11. The sheath (10) according to claim 9 or 10,comprising a sleeve (28) which encases the base sheath (20) and theexpansion device (26) such that the sleeve (28) is in contact with thevessel aperture in the stationary position of the sheath (10) in thevessel.
 12. The sheath (10) according to claim 10, comprising a sleeve(28) which encases the base sheath (20) and the expansion sheath (26)such that the sleeve (28) is in contact with the vessel aperture in thestationary position of the sheath (10) in the vessel, and that theexpansion sheath (26) is displaceable on the base sheath (20) betweenthe base sheath (20) and the sleeve (28).
 13. The sheath (10) accordingto any of claims 9 to 12, wherein the expansion device (26) is adaptedto increase the outer diameter (d) of the sheath (10) in the region ofthe vessel aperture by 0.33 mm to 1.0 mm, preferably 0.33 mm to 1.33 mm,particularly preferably 0.33 mm to 1.66 mm.
 14. The sheath (10)according to any of claims 1 to 13, wherein the sheath (10) includes anexternally readable marked region (29 a, 29 b) in an area of the sheath,which, in operation, is intended to be located in the area of the vesselpuncture site.
 15. The sheath (10) according to any of claims 1 to 14,comprising a fixation element (60) for fixing the sheath (10) to apatient, with the fixation element (60) having an area (62) spanning thebase sheath (20) for applying a sterile cover, with the area (62)sloping down in a ramp shape on both sides of the base sheath (20)transversely to the principal direction of the base sheath.
 16. Thesheath (10) according to claim 15, wherein the fixation element (60)comprises a stop (64) for applying the sterile cover, said stopextending at the proximal end of the area (62) transversely to theprincipal direction of the base sheath.
 17. The sheath (10) according toany of claims 1 to 16, comprising a heart pump (70) having a supplycatheter (40), with the sheath (10) being adapted to be arrangeddisplaceably on the supply catheter (40).
 18. A method for determining asufficient penetration depth of a sheath (10) according to any of claims1 to 17 into a vessel of an animal or human body, comprising the stepof: inserting the sheath (10) through the animal or human tissue intothe vessel to a depth at which blood conducted from the vessel via thethrough channel (27) or a blood pressure signal becomes recognizable atthe proximal end of the through channel (27).